Liver Cancer Study Group of Japan, Japan Society of Hepatology, Tokyo, Japan.
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2021 Oct;28(10):801-811. doi: 10.1002/jhbp.1000. Epub 2021 Jul 7.
It is unclear to what extent a board certification system and implementation of clinical guidelines improves the quality of hepatectomy.
A web-based questionnaire survey was administered to departments registered with the National Clinical Database (NCD) in Japan between 1 October 2014 and 31 January 2015. Quality indicators (QIs), including affiliations with academic societies, numbers of board-certified doctors affiliated with each institute, and adherence to clinical practice guidelines for hepatocellular carcinoma, were evaluated by calculating risk-adjusted odds ratios (AORs) for 90-day postoperative mortality of patients who had undergone hepatectomy in 2013 and 2014.
Of 1255 departments that had registered at least one hepatectomy in NCD, 592 departments, performing 8601 hepatectomies in total, responded to the questionnaire. AORs were significantly lower in departments that were certified as training hospitals by the Japanese Society of Gastroenterological Society, Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS), and Japan Society of Hepatology than in non-certified departments. Affiliation of three or more JSHBPS-certified experts or instructors with an institution also contributed to low AORs. None of the QIs regarding implementation of guidelines significantly impacted on the AOR.
Quality indicator measurements may improve quality of post-hepatectomy outcomes in Japan.
目前尚不清楚委员会认证制度和临床指南的实施在多大程度上提高了肝切除术的质量。
2014 年 10 月 1 日至 2015 年 1 月 31 日，对在日本国家临床数据库（NCD）注册的科室进行了基于网络的问卷调查。通过计算 2013 年和 2014 年接受肝切除术患者的 90 天术后死亡率的风险调整比值比（AOR），评估了质量指标（QI），包括与学术协会的关系、每个研究所的委员会认证医生的数量以及对肝细胞癌临床实践指南的遵守情况。
在至少在 NCD 注册了一次肝切除术的 1255 个科室中，有 592 个科室对问卷做出了回应，共进行了 8601 次肝切除术。在被日本胃肠病学会（JSG）、日本肝胆胰外科学会（JSHBPS）和日本肝病学会（JSH）认证为培训医院的科室中，AOR 明显较低。与一个机构有三个或更多 JSHBPS 认证专家或讲师的联系也有助于降低 AOR。指南实施方面的 QI 没有一个对 AOR 产生显著影响。
质量指标的测量可能会改善日本肝切除术后的结果质量。
